Miki K, Ichinose M, Ishikawa K B, Yahagi N, Matsushima M, Kakei N, Tsukada S, Kido M, Ishihama S, Shimizu Y
First Department of Internal Medicine, Faculty of Medicine, University of Tokyo.
Jpn J Cancer Res. 1993 Oct;84(10):1086-90. doi: 10.1111/j.1349-7006.1993.tb02805.x.
A considerable number of gastric cancers derive from stomach mucosa where chronic atrophic gastritis is severe and extensive. Based on the fact that the serum pepsinogen levels provide a precise measure of the extent of chronic atrophic gastritis, we have devised a mass screening method involving serum pepsinogen measurement to identify subjects at high risk of gastric cancer. In 1991, we screened 4,647 workers (male: 4,113, female: 534, mean age: 49.0 years) at a Japanese company using this method. Out of 875 subjects (18.8%) with a serum pepsinogen I level of less than 50 micrograms/liter and a pepsinogen I/II ratio of less than 3.0, 676 subjects (14.5%) were selected for further investigation by endoscopy. This led to the detection of four subjects (0.086%) with gastric cancer (three in an early stage) and four subjects with adenoma. The cancer detection rate of this new screening method was comparable, and in some respects superior, to that of the traditional barium X-ray screening. Since the incidence of test-positive subjects was as low as 10% amongst subjects aged less than 40, this screening method appears to be especially useful for screening of younger generations. The new method is less expensive than the traditional barium X-ray and subjects experience little discomfort. Further, many serum samples can be quickly measured simultaneously. The results of this study have indicated that serum pepsinogen screening provides a valuable method for detecting gastric cancers.
相当一部分胃癌起源于慢性萎缩性胃炎严重且广泛的胃黏膜。基于血清胃蛋白酶原水平能精确衡量慢性萎缩性胃炎程度这一事实，我们设计了一种通过检测血清胃蛋白酶原进行大规模筛查的方法，以识别胃癌高危人群。1991年，我们用此方法对一家日本公司的4647名员工（男性4113名，女性534名，平均年龄49.0岁）进行了筛查。在血清胃蛋白酶原I水平低于50微克/升且胃蛋白酶原I/II比值低于3.0的875名受试者（18.8%）中，有676名受试者（14.5%）被选出来接受进一步的内镜检查。结果发现了4名胃癌患者（0.086%，其中3名处于早期）和4名腺瘤患者。这种新筛查方法的癌症检出率与传统的钡餐X线筛查相当，在某些方面甚至更优。由于在40岁以下的受试者中，检测呈阳性的比例低至10%，所以这种筛查方法似乎对年轻一代的筛查特别有用。新方法比传统钡餐X线检查成本更低，受试者不适感小。此外，许多血清样本可以同时快速检测。本研究结果表明，血清胃蛋白酶原筛查为胃癌检测提供了一种有价值的方法。
